Nigerian National Health Insurance Scheme (NHIS): An overview.

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Obalum D. C., Fiberesima F.

Department of Surgery, State House Medical Centre, Aso Rock, Abuja Nigeria

Correspondence to: D. C. Obalum This e-mail address is being protected from spambots. You need JavaScript enabled to view it


According to the World Health Organization (WHO), in 2005, Nigeria was ranked 197th out of 200 nations. Life expectancy was put at 48 years for males and

50 years for females; while Healthy Life Expectancy (HALE) for both sexes was put at 42years. In HALE estimation, Nigeria only ranked higher than five countries; Sierra Leone, Afghanistan, Zimbabwe, Zambia and Lesotho1. The WHO report further stated that Nigeria accounts for 10 per cent of global maternal mortality figure, with 59,000 women dying annually from pregnancy and child birth1. It adds that for every maternal death, 30 others suffer long term disabilities while 40 per cent (about 800,000) of global obstetric fistulas occur in Nigeria1. The frightening report described the health situation in the country as being so deplorable because only 39 per cent of births are delivered by skilled health professionals. It also stated that the risk of a woman dying from child birth is 1 in 18 in Nigeria compared to 1 in 61 for all developing countries and 1 in

800 in developed countries, adding that only 23 per cent of children (12- 23months) receive full course of immunisation against childhood killer diseases1.

However, reducing child and maternal mortality rates are part of the Millennium Development Goals (MDG) which the Nigerian government is committed to. It targets a reduction of the mortality of children under the age of five by two-thirds between 2000 and 2015, that is, from 207 in 2000 to 67 by 20151. In the same vein, MDG also targets a 75 per cent decline in maternal mortality rate by 2015, that is, from 704 in 2000 to about 176 in 20151. It is therefore, obvious that unless there is a quick intervention, Nigeria will get to 2015 without a change in her health status. That is where the National Health Insurance Scheme (NHIS) comes in. The NHIS represents a very promising sustainable healthcare financing strategy. The agency can work progressively towards achieving universal health insurance coverage for all Nigerians.

Historically, Emperor Otto Von Bismarch of Germany enacted a mandatory legislation on ‘sickness funds’ for workers in 18832. As the cost of healthcare increases, it

has become increasingly important for people to obtain health insurance to maintain access to preventive and emergency health care and afford treatment. Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals. The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost3.

Given the general poor state of the nation’s health services and the excessive dependence and pressure on Government owned health facilities, with the dwindling funding of healthcare in the face of rising cost, the Scheme is designed to facilitate fair financing of health care costs through pooling and judicious utilisation of financial risk protection and cost-burden sharing for people, against high cost of health care through institution of prepaid mechanism, prior to their falling ill. This is in addition to the provision of regulatory oversight on Health Maintenance Organisations (HMOs) and Health Care Providers (HCPs).

Several health insurance schemes exist around the world. In Africa we have success stories in Rwanda, Kenya, Ghana, South Africa to reduce the burden of healthcare on the populace. This write up serves to highlight the history of NHIS, progress made so far, challenges and recommendations for the way forward towards achieving universal coverage.

History of NHIS

The Scheme was officially launched on 6th June

2005 and commencement of services to enrolees started in September 20051. Till date, over 4 million Identity Cards have been issued, 62 HMOs have been accredited and registered. Presently, 5,949 Healthcare Providers, 24 Banks,

5 Insurance Companies and 3 Insurance Brokers have also been accredited and registered1. In the list of states that have so far shown their interests are: Rivers, FCT, Benue,


 

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Account Name
NPMJ
Bank Name GT Bank(USD)
Account Number 0141316148